Gulcu Anil, Akman Alp, Demirkan Ahmet Fahir, Yorukoglu Ali Cagdas, Kaleli Ilknur, Bir Ferda
Orthopedics and Traumatology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
Microbiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
PLoS One. 2016 Nov 2;11(11):e0165544. doi: 10.1371/journal.pone.0165544. eCollection 2016.
Gentamicin is the preferred antimicrobial agent used in implant coating for the prevention of implant-related infections (IRI). However, the present heavy local and systemic administration of gentamicin can lead to increased resistance, which has made its future use uncertain, together with related preventive technologies. Fosfomycin is an alternative antimicrobial agent that lacks the cross-resistance presented by other classes of antibiotics. We evaluated the efficacy of prophylaxis of 10% fosfomycin-containing poly(D,L-lactide) (PDL) coated K-wires in a rat IRI model and compared it with uncoated (Control 1), PDL-coated (Control 2), and 10% gentamicin-containing PDL-coated groups with a single layer of coating. Stainless steel K-wires were implanted and methicillin-resistant Staphylococcus aureus (ATCC 43300) suspensions (103 CFU/10 μl) were injected into a cavity in the left tibiae. Thereafter, K-wires were removed and cultured in tryptic soy broth and then 5% sheep blood agar mediums. Sliced sections were removed from the tibiae, stained with hematoxylin-eosin, and semi-quantitatively evaluated with X-rays. The addition of fosfomycin into PDL did not affect the X-ray and histopathological evaluation scores; however, the addition of gentamicin lowered them. The addition of gentamicin showed a protective effect after the 28th day of X-ray evaluations. PDL-only coating provided no protection, while adding fosfomycin to PDL offered a 20% level protection and adding gentamicin offered 80%. Furthermore, there were 103 CFU level growths in the gentamicin-added group, while the other groups had 105. Thus, the addition of fosfomycin to PDL does not affect the efficacy of prophylaxis, but the addition of gentamicin does. We therefore do not advise the use of fosfomycin as a single antimicrobial agent in coating for IRI prophylaxis.
庆大霉素是用于植入物涂层以预防植入物相关感染（IRI）的首选抗菌剂。然而，目前庆大霉素大量的局部和全身给药会导致耐药性增加，这使得其未来的使用以及相关预防技术变得不确定。磷霉素是一种替代抗菌剂，不存在其他类抗生素所具有的交叉耐药性。我们在大鼠IRI模型中评估了含10%磷霉素的聚（D，L-丙交酯）（PDL）涂层克氏针的预防效果，并将其与未涂层（对照组1）、PDL涂层（对照组2）以及含10%庆大霉素的单层涂层PDL涂层组进行比较。植入不锈钢克氏针，并将耐甲氧西林金黄色葡萄球菌（ATCC 43300）悬液（103 CFU/10 μl）注入左胫骨的腔隙中。此后，取出克氏针，在胰蛋白胨大豆肉汤中培养，然后接种于5%绵羊血琼脂培养基上。从胫骨取出切片，用苏木精-伊红染色，并通过X射线进行半定量评估。将磷霉素添加到PDL中并不影响X射线和组织病理学评估得分；然而，添加庆大霉素会使其降低。在X射线评估的第28天后，添加庆大霉素显示出保护作用。仅PDL涂层没有提供保护作用，而在PDL中添加磷霉素提供了20%的保护水平，添加庆大霉素提供了80%的保护水平。此外，添加庆大霉素的组中有103 CFU水平的生长，而其他组有105 CFU水平的生长。因此，在PDL中添加磷霉素不影响预防效果，但添加庆大霉素会影响。因此，我们不建议将磷霉素作为单一抗菌剂用于IRI预防涂层。
